1487625729 NPI number — COUNTY OF DONIPHAN

Table of content: DR. PHILLIP MATTHEW MCPEAK M.D. (NPI 1497193486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487625729 NPI number — COUNTY OF DONIPHAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF DONIPHAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DONIPHAN COUNTY HEALTH DEPARTMENT/HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487625729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
201 S. MAIN
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66087-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-985-3591
Provider Business Mailing Address Fax Number:
785-985-3550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66087-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-985-3591
Provider Business Practice Location Address Fax Number:
785-985-3550
Provider Enumeration Date:
01/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
785-985-3591

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  A-022-001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: A-022-001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100094720A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100094720B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12781 . This is a "BCBS HEALTH DEPARTMENT" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100068770A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0259 . This is a "BCBS HOME HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 10001450000 . This is a "CHP HOME HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".